HIV Prevention:

A Winnable Battle

Centers for Disease Control and Prevention

 Burden of HIV in the United States

1.2 M ~50K
1.2 million people living with HIV Approximately 50,000 new infections annually

86% 4 in 10 3 in 10
86% of people living with HIV 4 in 10 people living with HIV 3 in 10 people living
know their diagnosis are in HIV medical Care with HIV achieved viral
suppression
 HIV Prevalence and New Infections
1980-2011

Number of people living with HIV has grown because

incidence is relatively stable and survival has increased
Hall HI et al. JAMA 2008 Aug 6;300(5):520-9; Prejean J et al PLoS One 2011;6(8):e17502; MMWR 2012 Mar 2;61(8):133-8
 Burden of HIV in the United States

Lifetime treatment costs of ~$400,000

ART
People living with HIV who start
antiretroviral treatment (ART) early
are now expected to live at least an
additional 39 years
 Rates of Diagnoses of HIV Infection among People
2011—United States and 6 Dependent Areas
N = 50,007 Total Rate = 19.1
9.5
VT 2.3
2.6 5.2 NH 4.5
2.6
8.0 7.2 MA 22.5
3.0 RI 14.0
3.8 5.7 30.1
3.4 CT 14.2
9.6
NJ 21.1
5.0 14.3
17.7 5.1 DE 16.7
4.3 12.6
20.0 MD 36.4
19.2 9.6 6.6 16.2 DC 177.9
6.2 11.2
9.4
20.8
17.3
13.3 10.7
8.6 10.0 22.0
25.3 20.9 31.4
American Samoa &
Guam 0.0
24.5 Northern Mariana 0.0
36.6 Islands 5.3
4.6 Puerto Rico 28.6
Rates per 100,000
6.8 Republic of Palau 0.0
population
U.S. Virgin Islands39.5
<10.0
10.0 – 19.9
20.0 – 29.9
≥30.0
Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All
displayed data have been statistically adjusted to account for reporting delays, but not for incomplete
reporting.
 Stark disparities in HIV and AIDS among
different groups

 95% of people with HIV are men who have sex with
men (MSM), African Americans, Latinos, or injection
drug users (IDU)
 MSM are >40 times more likely to have HIV than
other men and women
 African American men and women are 8 times more
likely than whites to have HIV
 Latino men and women are 3 times more likely to
have HIV than whites

CDC, HIV Surveillance Report,2008. Published June 2010. www.cdc.gov/hiv/surveillance/resources/reports

MSM = Men having sex with men
IDU = Intravenous drug users
 Diagnoses of HIV Infection and Population
by Race/Ethnicity, 2013—United States

Note. Data include persons with a diagnosis of HIV infection regardless of stage of disease at diagnosis. All displayed data
have been statistically adjusted to account for reporting delays, but not for incomplete reporting.
a Hispanics/Latinos can be of any race.
 HIV prevention works
Saves lives and money
 Collective prevention efforts have led to a dramatic
reduction in HIV infections
 130,000 estimated new HIV infections per year in 1985
 47,500 new HIV infections in 2010

 Conservative estimates are that prevention efforts

have:
 Averted more than 350,000 HIV infections in the United States
 Saved more than $125 billion in medical costs
 Reducing incidence by 25%
 In 10 years would save 62,000 infections and $23 billion
 In 5 years would prevent 109,000 infections and $42 billion
Source: Holtgrave DR. Written testimony on HIV/AIDS incidence and prevention for the US House of Representatives Committee
on Oversight and Government Reform. September 16, 2008.
 What can be done to
reduce HIV infections?
 A National Call for HIV Prevention

• The White House released the National HIV/AIDS

Strategy (NHAS) on July 13, 2010, as a roadmap for all
public and private stake-holders to align their efforts
with the following goals:
• Decrease incidence of HIV
• Increase access to care and improve health outcomes for
people with HIV
• Reduce HIV-related health disparities
 High-Impact Prevention (HIP)

• To achieve the goals of NHAS, CDC

and its partners are pursuing a high-
impact prevention (HIP) approach to
reduce new HIV infections by
– using scientifically proven, cost-effective,
and scalable interventions; and

– targeting those interventions to the right

populations (men having sex with men,
African Americans, Hispanics/Latinos,
Injection drug Users and Transgender
individuals) in the right geographic areas.

Available for download at:

http://www.cdc.gov/hiv/policies/hip.html
 HIV Prevention Interventions
 HIV testing and linkage to care
 Antiretroviral therapy
 Access to condoms and sterile syringes
 Prevention programs for people living with HIV and
their partners
 Prevention programs for people at high risk for HIV
infection
 Substance abuse treatment
 Screening and treatment for other sexually
transmitted infections
 HIV Care Continuum Shows
Improvements are Needed
Estimated percentage of persons living with HIV infection,
by outcome along the HIV care continuum, 2011
100
90 86%
80
70
60
50
39.8% 36.8%
40
30.1%
30
20
10
0
Diagnosed Received Medical Care Prescribed Anti- Virally Suppressed
Retroviral Therapy
 Testing and Diagnosis

When people learn they are infected,

they take steps to protect their own
health and prevent HIV transmission
to others.
 14% (168,000) of people with
HIV are undiagnosed
 86% (1,032,000) have been
diagnosed with HIV
• More likely than undiagnosed to
access prevention and treatment

Sources: CDC National HIV Surveillance System and

Medical Monitoring Project, 2011.
 Linkage to and Engagement in Care
 Linkage to care helps ensure people living with HIV
receive life-saving medical care and treatment, and
helps reduce their risk of transmitting HIV.
 40% of people living with HIV have received regular
HIV medical care.
 Once in medical care, people get HIV medicines and
prevention services to help them stay healthy and
protect their partners.
 Antiretroviral Therapy
 Treating people living with HIV early in their infection improves
their health, prolongs their lives and dramatically reduces the
risk of transmitting the virus to others.

 Only 37% of people living with HIV are prescribed HIV medicines
 Of patients in HIV medical care, 92% are prescribed HIV medicines
 Only 30% of people living with HIV have achieved viral suppression
 Of patients in HIV medical care, 76% achieve viral suppression

 Antiretroviral drugs (ARVs):

 Reduce risk of perinatal transmission
 Reduce infectiousness
 Keep immune systems functioning properly
 Prevent opportunistic infections and
 Slow down the progression of HIV to AIDS
 Access to Condoms and Sterile Syringes
 In order for HIV prevention efforts to work, people
who are living with, or at risk for, HIV infection need
access to effective prevention tools.

 Research shows that increasing the availability of

condoms and sterile syringes is associated with
reductions in HIV risk.
 Prevention Programs for People Living with
HIV and their Partners
 Individual and small-group interventions reduce risk
behaviors among people living with HIV to help
ensure they do not transmit the virus to others.

 Partner services reduce the spread of HIV by

confidentially identifying and notifying partners who
may have been unknowingly exposed to HIV,
providing them with HIV testing, and linking them to
care.
 Prevention Programs for
High-Risk Populations
 Individual, small-group, and community
interventions for people who are at high risk of HIV
infection can reduce risk behavior and play an
important role in many HIV prevention strategies.

 Support targeted efforts to prevent new infections in

persons who are lesbian, gay, bisexual, transgender
(LGBT), and other men who have sex with men
(MSM), to ensure they are diagnosed early and
remain in care, when infected.
 Substance Abuse Treatment
 Effective substance abuse treatment that helps drug
users stop injecting eliminates the risk of HIV
transmission through injection drug use.
 STI Screening & Treatment Interventions

 Many sexually transmitted infections (STIs) increase

an individual's risk of acquiring and transmitting HIV,
and STI treatment may reduce HIV viral load.

 STI screening and treatment may reduce risk for HIV

transmission.
 New Powerful Prevention Tools
 Pre-exposure prophylaxis (PrEP):
 Allows HIV-uninfected people who are at
substantial risk of getting HIV to take a pill
daily

 Potential Users: sexual partner who has

HIV, multiple partners, frequent STDs, or
other evidence of high risk

 Federal PrEP Guidelines issued May 2014

 Non-occupational Post-exposure
prophylaxis (nPEP):
 Involves taking medicines no more than 72
hours (3 days) after you may have been
exposed to HIV
Act Against AIDS™ National Umbrella Program

Provider Consumer Partnerships

Campaigns Campaigns & Community
Engagement

• Increase information-seeking behaviors,

knowledge and awareness about HIV
• Increase targeted behavior change, including HIV
prevention and testing, for high-risk populations
and physicians who serve those populations
• Provide national, credible leadership in HIV
prevention
 Raising Awareness
• Campaign Materials
• Awareness Day
Materials
• Websites
• CDC Info
• Weekly Electronic
Publications
• Conference Exhibiting
 “The United States will become a place where new
HIV infections are rare and when they do occur, every
person, regardless of age, gender, race/ethnicity,
sexual orientation, gender identity or socio-economic
circumstance, will have unfettered access to high
quality, life-extending care, free from stigma and
discrimination.”
—Vision of the National HIV/AIDS Strategy